Carotid bruit
WikiDoc Resources for Carotid bruit |
Articles |
---|
Most recent articles on Carotid bruit Most cited articles on Carotid bruit |
Media |
Powerpoint slides on Carotid bruit |
Evidence Based Medicine |
Clinical Trials |
Ongoing Trials on Carotid bruit at Clinical Trials.gov Trial results on Carotid bruit Clinical Trials on Carotid bruit at Google
|
Guidelines / Policies / Govt |
US National Guidelines Clearinghouse on Carotid bruit NICE Guidance on Carotid bruit
|
Books |
News |
Commentary |
Definitions |
Patient Resources / Community |
Patient resources on Carotid bruit Discussion groups on Carotid bruit Patient Handouts on Carotid bruit Directions to Hospitals Treating Carotid bruit Risk calculators and risk factors for Carotid bruit
|
Healthcare Provider Resources |
Causes & Risk Factors for Carotid bruit |
Continuing Medical Education (CME) |
International |
|
Business |
Experimental / Informatics |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ogheneochuko Ajari, MB.BS, MS [2]
Overview
A carotid bruit is a bruit or sound heard over the carotid artery area, usually by a nurse or physician during auscultation. It is usually the result of a stenosis of the carotid artery, and is unlikely to be heard if the stenosis occludes less than 40% of the diameter of the artery. Likewise, a stenosis of greater than 90% may not be heard, as the flow may be too low.
Causes
Life Threatening Causes
Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.
Common Causes
Causes by Organ System
Causes in Alphabetical Order [1] [2]
Diagnosis
Many carotid bruits are discovered incidentally in an otherwise asymptomatic patient. A carotid duplex ultrasound may be useful in determining the origin of the bruit, the severity of the stenosis causing it, and the bruit's hemodynamic effects.
- Carotid bruits are best heard with the bell of the stethoscope.
- Carotid bruits are a blowing sound or murmur over the carotid artery
- Are usually associated with carotid stenosis, secondary to atherosclerosis
- Depending on degree of stenosis, may imply an increased risk of stroke
History and Symptoms
- Special attention should paid to symptoms suggestive of:
- Transient ischemic attack (TIA) symptoms
- Cardiac risk factors
Physical Examination
Heart
- It is critical to assess if there is a heart murmur that is radiating to the carotids.
Abdomen
- The presence of a carotid bruit may indicate that a renal bruit is present as well.
Extremities
- The presence of a carotid bruit may indicate that a femoral artery bruit will be present as well. The distal pulses should be evaluated carefully.
Neurologic
- Neurologic exam should document and focal neurologic findings that might suggest a prior stroke.
Laboratory Findings
- Complete blood count (CBC)
- Lipid panel
- Folate levels
- Vitamin B12
- Thyroid stimulating hormone (TSH)
- Glucose
- Homocysteine level
- Erythrocyte sedimentation rate (ESR)
Echocardiography or Ultrasound
- The degree of stenosis can be evaluated by carotid duplex ultrasound.
- A CT scan may be indicated for patients with ultrasound-proven carotid disease who are at a higher risk for cerebrovascular accidents such as stroke.
Other Imaging Findings
- To evaluate symptomatic stenosis that may require surgery:
- Computerized tomographic angiography (CTA)
- Magnetic resonance angiogram (MRA)
- Carotid arteriography
Treatment
- Treat underlying atherosclerotic disease proceses.
- Smoking cessation
Pharmacotherapy
Acute Pharmacotherapies
- Aspirin and/or antiplatelet therapy is recommended for asymptomatic patients
Chronic Pharmacotherapies
- Aspirin and/or antiplatelet therapy is recommended for asymptomatic patients
Surgery and Device Based Therapy
- Symptomatic patients with stenosis of 50-69% benefit more from surgery than medical therapies
- Symptomatic patients with stenosis of greater than 70% should consider endarterectomy
Future or Investigational Therapies
- Carotid angioplasty is under investigation for a possible future treatment
References
- ↑ Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016
- ↑ Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:68 ISBN 140510368X
- ↑ Sauvé J, Laupacis A, Østbye T, Feagan B, Sackett DL. Original article: does this patient have a clinically important carotid bruit? In: Simel DL, Rennie D, eds. The Rational Clinical Examination: Evidence-Based Clinical Diagnosis. New York, NY: McGraw-Hill; 2009. http://www.jamaevidence.com/content/3476758. Accessed 1/7/2015
- ↑ Demiryoguran NS, Karcioglu O, Topacoglu H, Aksakalli S (2006). "Painless aortic dissection with bilateral carotid involvement presenting with vertigo as the chief complaint". Emerg Med J. 23 (2): e15. doi:10.1136/emj.2005.027862. PMC 2564071. PMID 16439729.
- ↑ Sauvé J, Laupacis A, Østbye T, Feagan B, Sackett DL. Original article: does this patient have a clinically important carotid bruit? In: Simel DL, Rennie D, eds. The Rational Clinical Examination: Evidence-Based Clinical Diagnosis. New York, NY: McGraw-Hill; 2009. http://www.jamaevidence.com/content/3476758. Accessed 1/7/2015
- ↑ Rymer JA, Anderson LL, Posenau JT, Jones WS (2013). "Remote Stab Wound Resulting in AV Fistula and High-Output Heart Failure". Case Rep Cardiol. 2013: 902719. doi:10.1155/2013/902719. PMC 4008354. PMID 24826298.
- ↑ Bavinzski G, Richling B, Killer M, Gruber A, Levy D (1996). "Evolution of different therapeutic strategies in the treatment of cranial dural arteriovenous fistulas--report of 30 cases". Acta Neurochir (Wien). 138 (2): 132–8. PMID 8686535.
- ↑ Lawrence PF, Oderich GS (2002). "Ophthalmologic findings as predictors of carotid artery disease". Vasc Endovascular Surg. 36 (6): 415–24. PMID 12476231.
- ↑ Hill SL, Holtzman GL, Berry R, Arnold JF (1997). "The appropriate use of the duplex scan in carotid arterial disease". Am Surg. 63 (8): 720–5. PMID 9247441.
- ↑ Chambers BR, Norris JW (1985). "Clinical significance of asymptomatic neck bruits". Neurology. 35 (5): 742–5. PMID 3887214.
- ↑ Wu HC, Chen YC, Chen CJ, Chen ST, Lee TH (2006). "Spontaneous bilateral internal carotid artery dissection with acute stroke in young patients". Eur Neurol. 56 (4): 230–4. doi:10.1159/000096491. PMID 17057383.
- ↑ Lindsay FW, Mullin D, Keefe MA (2003). "Subacute hypoglossal nerve paresis with internal carotid artery dissection". Laryngoscope. 113 (9): 1530–3. doi:10.1097/00005537-200309000-00022. PMID 12972929.
- ↑ Santilli JD, Santilli SM, Rodnick JE (1996). "Prevention of stroke caused by carotid bifurcation stenosis". Am Fam Physician. 53 (2): 549–56, 559–60. PMID 8629537.
- ↑ 14.0 14.1 Morales-Gisbert SM, Plaza-Martínez Á, Sala-Almonacil VA, Olmos-Sánchez D, Gomez-Palonés FJ, Ortiz-Monzón E (2013). "[Natural history of moderate-degree carotid stenosis in patients with peripheral artery disease]". Med Clin (Barc). 140 (8): 337–42. doi:10.1016/j.medcli.2012.06.031. PMID 23339889.
- ↑ Lacerda Gde C, Pedrosa RC, Lacerda RC, Santos MC, Perez Mde A, Teixeira AB; et al. (2008). "Cardioinhibitory carotid sinus hypersensitivity: prevalence and predictors in 502 outpatients". Arq Bras Cardiol. 90 (3): 148–55. PMID 18392392.
- ↑ Ebina K, Iwabuchi T (1978). "[Closure of traumatic internal carotid-cavernous fistula with an improved type of captive embolus (author's transl)]". No Shinkei Geka. 6 (1): 59–66. PMID 628507.
- ↑ Garland SD, Maloney PL, Doku HC (1977). "Carotid-cavernous sinus fistula after trauma to the head". J Oral Surg. 35 (10): 832–5. PMID 269234.
- ↑ Subramani KS, Kolhari VB, Manjunath CN, Bhairappa S (2013). "Familial hypercholesterolaemia presenting with coronary artery disease in a young patient". BMJ Case Rep. 2013. doi:10.1136/bcr-2013-008718. PMID 23519510.
- ↑ Frost PH, Davis BR, Burlando AJ, Curb JD, Guthrie GP, Isaacsohn JL; et al. (1996). "Coronary heart disease risk factors in men and women aged 60 years and older: findings from the Systolic Hypertension in the Elderly Program". Circulation. 94 (1): 26–34. PMID 8964114.
- ↑ 20.0 20.1 Taddio A, Maschio M, Martelossi S, Barbi E, Ventura A (2013). "Crohn's disease and Takayasu's arteritis: an uncommon association". World J Gastroenterol. 19 (35): 5933–5. doi:10.3748/wjg.v19.i35.5933. PMC 3793150. PMID 24124342.
- ↑ Olin JW, Sealove BA (2011). "Diagnosis, management, and future developments of fibromuscular dysplasia". J Vasc Surg. 53 (3): 826–36.e1. doi:10.1016/j.jvs.2010.10.066. PMID 21236620.
- ↑ Sauvé J, Laupacis A, Østbye T, Feagan B, Sackett DL. Original article: does this patient have a clinically important carotid bruit? In: Simel DL, Rennie D, eds. The Rational Clinical Examination: Evidence-Based Clinical Diagnosis. New York, NY: McGraw-Hill; 2009. http://www.jamaevidence.com/content/3476758. Accessed 1/7/2015
Acknowledgements
The content on this page was first contributed by Editor-In-Chief: C. Michael Gibson, M.S., M.D. [3]
List of contributors: